Is is your ambulance company integrating with the regional Accountable Care Organizations (ACO)?  How is it affecting service delivery in your area? 
The Patient Protection and Affordable Care Act of 2011 provides for the establishment of Accountable Care Organization (ACO) contracts with Medicare by January 2012. As stated in the Affordable Care Act, the ACO promotes accountability for a patient population, coordinates items and services under part A and B, and encourages investment in infrastructure and redesigned care processes for high quality and efficient service delivery. A quick lesson on the specifics of this groundbreaking legislation is available in this great Wiki article. 

A Look into the Future of EMS – Today

Forward thinking hospital systems and their local ambulance providers are exploring ways to reduce the expense of transporting patients to the Emergency Department for non emergent care as well as developing strategies to curtail readmission of patients once they are discharged from the hospital. The need to integrate the local ambulance provider into the regional Accountable Care Organization (ACO) is critical.

As it relates to managing patient readmission, hospital systems or the ACO should be looking to contract with local EMS organizations to provide the “at home” follow up of patients within 72 hours of discharge. The concept is that specially trained Paramedics would ensure medication compliance, take a baseline assessment of the patient and set up or confirm any follow up appointments the patient may have. 

Additionally, the ambulance company or first response agency could be tasked with the coordination of other transportation needs a patient may have. It is my recommendation that the Provider should establish sub-contracts with local taxi companies, wheelchair companies as well as other ambulance providers. 

 An Unfunded Mandate?

It is stated that the compensation mechanism comes directly from the ACO with Federal monies allocated for the development of the ACO. 

Essentially the ACO should pay an assessment fee for each patient follow up. This will generate a substantial additional revenue stream for the EMS agencies but will result in an overall savings of Medicare money related to unnecessary readmission for failure to comply with discharge instructions. 

The motivation for the hospital to allocate this funding is to reduce readmissions (thus reducing penalties) and to ensure a high performing ACO. 

The current system of reimbursement for transporting a patient as the only funding stream for an EMS agency could be coming to an end. EMS agencies wouldn’t just be compensated for moving the patient to the highest level of care: The emergency department. They could be compensated for care that really will benefit patients and make the healthcare system more efficient.

What Can Your Company Do?

First and foremost, EMS agencies need to start working with their local hospitals to develop an understanding of the ACO concept. The best mechanism for this is to develop a task force or committee that includes members from the EMS and Hospital System. Initial discussions should include the EMS role in alleviating emergency department overcrowding through better triage at the 911 dispatch center, paramedic initiated treat-and-release programs, and transportation to alternate destinations.  

Additionally, organizations that manage to achieve seamless patient information exchange through the integration of data, stand to gain an insurmountable advantage and unparalleled opportunity in the fast-moving healthcare landscape.

This is potentially a win-win for both EMS and the Hospital system. If the leaders making the decisions understand the opportunity and are willing to throw out preconceived notions of how the system should work, then we are in for a very exciting time in the EMS world.For more information visit Michael Shabkie at http://www.engage911.net.